Challenges and progress in the diagnosis and treatment of carcinomatous meningitis

Publication Type:

Journal Article

Source:

International journal of molecular medicine, Volume 32, p.S38-S38 (2013)

ISBN:

1107-3756

Keywords:

2013, Clinical Research Division, November 2013, Research & Experimental Medicine

Abstract:

Carcinomatous meningitis (CM) is a serious complication of cancer and can occur in association with solid tumors and hematologic malignancies. The incidence of this complication is increasing as patients with cancer live longer and effective systemic therapies with limited CNS penetration are utilized. This devastating complication of cancer can occur early in the course of the illness but most patients develop it later, sometimes synchronously with progressive systemic disease. Cancers most frequently associated with CM include breast, lung and melanoma followed by hematologic malignancies. Symptoms associated with CM can be quite non-specific which frequently leads to delayed diagnosis and introduction of treatment. Diagnostic work up includes imaging of the entire neuraxis and cerebro-spinal fluid analysis for detection of malignant cells. Occasionally, the diagnosis might be quite challenging and strong clinical suspicion of CM should guide the clinician in decision making and early intervention. Therapy of CM can be divided into local and systemic. Chemotherapy is the primary treatment with surgical intervention rarely needed to treat secondary complications of CM such as hydrocephalus or to achieve the diagnosis thru meningeal biopsy. Radiotherapy can be useful in treatment of diffuse or bulky disease. Chemotherapy can be given systemically when agents known to penetrate blood-brain barrier are used. In most cases, intrathecal approach is used with chemotherapy being delivered either via intraventricular catheter or via lumbar puncture. Variety of agents are available for intrathecal administration. Most commonly used agents include: methotrexate, cytarabine and thiotepa. More recently, monoclonal antibodies were introduced in patients with lymphomatous meningitis and patients with CM secondary to breast cancer. Despite aggressive therapy, prognosis in patients with CM is poor and the median survival is usually less than 3-4 months but depends on histology of the primary malignancy and can be as long as 7 months in breast cancer patients. Novel diagnostic methods and better treatments are needed to treat this complication of cancer more successfully.

Notes:

PT: J; NR: 0; TC: 0; J9: INT J MOL MED; SU: 1; PG: 1; GA: 219LC